Dignity, but for whom?

Prof. Shah Alam Khan, Professor in the Department of Orthopaedics at the All India Institute of Medical Sciences writes that the verdict of the Supreme Court in Common Cause v. UOI, does not take into account socioeconomic realities.

He writes that death is inevitable. The Supreme Court judgment has added morality to death, which he believes is immoral. Additionally, a living will is a privilege available only to the educated class. This makes the provision of passive euthanasia in India exclusive to the educated class.

Prof. Khan finds it outrageous that the legal provisions of developed nations on a contentious issue like euthanasia are being emulated in India. He finds the judgement problematic as it bestows death, through passive euthanasia, on some while actively denying it to others. He also finds the definition of terminal illness and vegetative state very broad. Patients have been known to come out of their terminal states to lead a normal life. He warns against the misuse of passive euthanasia by doctors, kin, and patients themselves.

Prof. Khan calls for a review of the healthcare services before the concept of passive euthanasia as interpreted by the Court is accepted. While most passive euthanasia across the globe is practised by hospice and palliative care specialists, India’s healthcare facilities are among the poorest in the world. In fact, hospice services are practically non-existent in India. Thus, he writes, there is no guarantee of a decent death to those patients who choose passive euthanasia.

Prof. Khan points out that the judgement says ‘It is to be borne in mind that passive euthanasia fundamentally connotes absence of any overt act either by the patient or by the doctors.’ He finds this interesting, as doctors are bound by acts or omissions which must further the patient’s welfare. The act or omission should help the patient get better. But, to slowly withdraw life support amounts to an act, thereby raising significant questions of morality. He warns against manipulation of this grey area.

He ends his piece by saying that for passive euthanasia to be seriously considered in a complex society like this must be based on the principles of medical ethics. He quotes Immanual Kant to buttress his point, that morality cannot be based on happiness, moral principles have to be derived from practical reason alone.